THE ADVOCATE Q3
From the Doctor’s Desk
By: Dr. Kim Panovka - Medical Director, CMN Inc.
Pertussis (Whooping Cough)
Whooping cough is an infection of the respiratory system caused by the bacteria Bordetella pertussis .It's characterized by severe coughing spells that end in a "whooping" sound when the person breathes in. The whoop originates from the inflammation and swelling of the laryngeal structures that vibrate when there is a rapid inflow of air during inspiration.
It is a serious disease that can cause permanent disability in infants, and even death.
When an infected person sneezes or coughs, tiny droplets containing the bacteria move through the air, and the disease is easily spread from person to person. The infection usually lasts 6 weeks.
If started early enough, antibiotics such as erythromycin can make the symptoms go away more quickly. Unfortunately, most patients are diagnosed too late, when antibiotics aren't very effective. However, the medicines can help reduce the patient's ability to spread the disease to others.
Infants younger than 18 months need constant supervision because their breathing may temporarily stop during coughing spells. Infants with severe cases should be hospitalized.
Cough mixtures, expectorants, and suppressants are usually not helpful and should NOT be used.
Possible complications include:
- Pneumonia
- Seizures
- Nose bleeds
- Ear infections
- Brain damage from lack of oxygen
- Apnea
- Death
In the pre-vaccination era there were over 250,000 cases of whooping cough per year in the U.S., with up to 9,000 deaths. In the 1940s, the pertussis vaccine, combined with diphtheria and tetanus toxoids (DTP), was introduced. By 1976, the incidence of whooping cough in the U.S. had decreased by over 99%.
Epidemics typically occur every three to five years in the U.S. In 2008, over 13,000 cases of whooping cough were reported in the U.S., resulting in 18 deaths.
In 2010, a pertussis epidemic was declared in California. The California Department of Public Health warned in June 2010 that the state was on pace to suffer the most illnesses and deaths due to whooping cough in the past 50 years.
The pertussis epidemic in California is taking its heaviest toll among infants, so state health authorities are trying to boost immunization in a population group thought to pass along the disease — adults.
The California Department of Public Health (CDPH) is shipping free pertussis vaccine to all birthing hospitals in the state, as well as county and municipal health departments. The department is encouraging not only new mothers and fathers to get immunized but also other family members, healthcare workers, child care workers, and anyone else who might have contact with infants.
For maximum protection against pertussis, children need five DTaP shots. The first three vaccinations are given at 2, 4, and 6 months of age. The fourth vaccination is given between 15 and 18 months of age, and a fifth is given when a child enters school, at 4-6 years of age. Preteens going to the doctor for their regular checkup at 11 or 12 years of age should get a dose of the Tdap booster, and adults who didn't get Tdap as a preteen or teen should get one dose of Tdap. The easiest way for adults to ensure immunity is to get the Tdap vaccine instead of their next regular tetanus booster. (The Td shot is recommended every 10 years.)
In some cases, pregnant women may desire vaccination with the Tdap vaccine or may be at risk for acquiring whooping cough. Although the U.S. CDC states that pregnancy is not a contraindication for receiving the Tdap vaccine, data on the safety of the vaccine in pregnant women are limited. The tetanus and diphtheria (Td) components of the vaccine are considered safe for pregnant women. If the Tdap vaccine is given in pregnancy, the CDC recommends that it be given in the second or third trimester. Pregnant women should consult their health-care provider for a discussion their individual situation regarding the pertussis vaccine.
References:
- CDC
- Medscape
- NIH
